2. Orange Surgery Chief Resident Expectations

Orange Surgery Chief Resident Expectations

This handout is designed to help you better understand your role and explicitly outline our expectations of chief residents on the Orange Surgery service.

Prior to the first day of the rotation, please complete the required robotic surgery training as per the training curriculum. (Please contact Dr. Ferguson with any questions.) Completion of online modules and the simulation curriculum is required.

GOALS:

This rotation will expose residents to the diagnosis, workup, and management of complex abdominal wall pathology, as well as foregut conditions.

LEARNING OBJECTIVES:

By the end of the rotation, the resident is expected to have the following knowledge:

  1. A comprehensive understanding of abdominal wall anatomy and function.
  2. A comprehensive understanding of the diagnosis and workup of various types of hernias, including: groin hernias, primary ventral hernias, incisional hernias, recurrent hernias, and off-midline hernias.
  3. The ability to diagnose and describe the above types of hernias based on CT imaging.
  4. A thorough understanding of the various considerations for hernia repairs, including: surgical approach (open vs. MIS), indications and contraindications for mesh, types of mesh, mesh positions (and pros/cons of each), and indications for component separation. Residents should be able to provide treatment recommendations to patients in straight-forward cases.
  5. A basic understanding of the workup and treatment options for loss-of-domain hernias.
  6. A thorough understanding of the potential complications of hernia surgery and their management, including: hernia recurrence, mesh infection, enterocutaneous fistula, semilunar line injury, and “Mickey Mouse hernias”.

The resident is expected to demonstrated the following technical skills:

  1. Safe abdominal entry in the complex patient (multiple prior operations, current bowel obstruction, very large hernia, etc.)
  2. Troubleshooting of laparoscopic and robotic technology
  3. Be able to describe and/or perform key steps of the following procedures (under supervision):
    1. Umbilical hernia repair (describe and perform)
    2. Open inguinal hernia repair (describe and perform)
    3. Robotic and/or laparoscopic inguinal hernia repair (describe and perform)
    4. Robotic ventral hernia repair (eTEP) (describe and perform)
    5. Open ventral hernia repair (Rives Stoppa) (describe and perform)
    6. Open ventral hernia repair with component separation (describe)

CLINICAL CARE EXPECTATIONS:

  • Provide comprehensive care to all patients on your service. This includes:
    • Lead morning and afternoon team rounds.
    • Know patients’ intake/output, including drain output volume and quality.
    • Review new lab and imaging results.
    • Be aware of current orders and ensure they are correct. This includes: appropriate multimodal pain medications, VTE prophylaxis, diet, IV fluids, resumption of home medications as appropriate, etc.
    • Ensure comprehensive handoffs for complex patients.
  • Provide daily updates to Dr. Ferguson (or covering faculty) on designated hernia patients via Teams or in person. Updates should be sent before morning report when possible, or by 8am, in order to allow for sufficient time to communicate changes in plans to the team, patient, and other staff.
    • If there is no acknowledgement from faculty, please directly text or call, as Teams notifications are not always reliable.
    • For urgent communications, always call faculty directly.
  • Ensure that hernia patients have clear, concise, and informative daily progress notes by reviewing notes written by junior residents and providing feedback as necessary. Notes for designated hernia patients should be sent to Dr. Ferguson daily.
  • Prep hernia clinic
    • Hernia clinic is the 2nd and 4th Monday of every month.
    • Review the clinic schedule during the week before to ensure appropriate patient volume and maximize clinic efficiency.
      • Come up with tentative management plans for new & return hernia patients (e.g., “Patient potentially a candidate for [XYZ] repair, but needs to lose weight first”),
      • Ensure return patients have had appropriate studies/workup based on last clinic note (i.e., if the patient needed a CT before returning but it has not been done, message Kenya Steward to reschedule for after the CT).

OPERATING ROOM:

  • Case preparation
    • Preop cases for Wednesday conference.
    • Review the patient’s imaging, history, and other relevant information.
    • Review the relevant anatomy and prepare for the case by whatever means appropriate (review videos for robotic cases, textbooks for open cases, etc.).
  • Preop patients
    • Evaluate for any changes in health status, medications, social status (i.e. patient did not resume smoking), or physical exam.
    • Ensure patient has been appropriately consented and counseled about the anticipated postoperative course.
    • Ensure preoperative paperwork is completed before morning report so there are no delays in starting the case.
  • Intraoperative participation
    • Stay engaged during the case, regardless of role (actively operating versus assisting, etc.).

CONFERENCES:

In addition to required divisional and departmental meetings, there are several hernia-specific conferences you are expected to attend:

  • Hernia Journal Club – held monthly (contact Dr. Ferguson if you haven’t received an invite)
  • Texas Hernia Center Case Conference – held monthly (contact Dr. Ferguson if you haven’t received an invite)